Long Thoracic Nerve Injury

Aka: Long Thoracic Nerve Injury, Long Thoracic Nerve Palsy, Long Thoracic Nerve Lesion

1. See Also
   1. Peripheral Nerve Injury
2. Anatomy
   1. Long Thoracic Nerve forms from C5-7 nerve roots at the middle scalene muscle
3. Causes
   1. Direct blow to Shoulder
   2. Direct blow to pectoralis muscle at rib 4-5 at nerve exit site
   3. Chronic repetitive overhead Shoulder traction (e.g. tennis, volleyball, swimming, baseball)
   4. Traction injury at the middle scalene muscle
   5. Radical Mastectomy
4. Symptoms
   1. Diffuse Shoulder or Neck Pain with overhead activity
5. Signs
   1. Forward flexion weakness at Shoulder
   2. Scapular winging
6. Diagnostics
   1. Nerve Conduction Studies and EMG
   2. Shoulder MRI
      1. Not typically indicated but may show supraspinatus and infraspinatus denervation changes
7. Management
   1. Shoulder Range of Motion Exercises
      1. Prevents Frozen Shoulder and contractures
   2. Strengthen remaining Shoulder stabilizing muscles
      1. Trapezius Muscles
      2. Rhomboid Muscles
      3. Levator Scapula Muscle
   3. Surgery is rarely indicated
      1. Consider surgery for Penetrating Trauma with nerve transection
      2. Consider surgery for lack of improvement at 18 to 24 months
8. Course
   1. Therapy leads to recovery times typically of 9-12 months (may require up to 2 years)
9. References
   1. Neal (2010) Am Fam Physician 81(2): 147-55 [PubMed]
   2. Safran (2004) Am Sports Med 32(4): 1063-76 [PubMed]
   3. Silver (2021) Am Fam Physician 103(5): 275-85 [PubMed]